all right so now we are on beta blockers these are olals okay so at the end or the suffix of medication names for this particular class you will see olol which will help you differentiate that this is a beta adrenergic blocker okay it's an antagonist because it blocks all right so when we say um adrenergic beta adrenergic blocker right we're referring to adrenerg adrenergic and adrenergic works on adrenal adrenaline i cannot talk today sorry adrenaline or epinephrine norepinephrine okay so beta adrenergic blocker so it's blocking um the effects of adrenaline or epi or norepinephrine okay which is going to stimulate some cardiac activity but we're blocking that okay so mechanism of action it binds to and blocks beta 1 so beta 1 let's go to a slide really quick this is good okay so beta 1 these are primary primarily located on the surface of the heart okay beta 1 receptors that's where they're located beta 2 receptors are primary primarily located on the smooth muscles of the bronchioles um and then blood vessels that are found in like arteries of skeletal muscles too but you see primarily beta 2 in the lungs on the bronchioles okay so know that when we talk about beta 1 we're referring to the heart but the two we're referring to receptors of the lungs okay um we have different types of beta adrenergic blockers and some of them are what's called cardioselective and some of them are non-selective and then just let me scroll here really quick so this is a really good picture too that helps to will help you remember before we get too far ahead is beta 1 affects the heart beta 2 affects the lungs okay so i would always think of this picture in my head whenever i'm trying to differentiate these okay so back to what i was saying cardioselective if i'm saying it is a beta-adrenergic blocker that is cardioselective i'm saying that it binds to and blocks beta 1 receptors in our heart's electrical conduction system okay if it's binding to and blocking beta 1 receptors and our electrical conduction system it's going to affect the heart rate so beta adrenergic blockers decrease heart rate because it works on that conduction system okay if i say it's a non-selective and you need to know the difference between the two okay if i say it's a non-selective beta adrenergic blocker what i'm saying is it binds to and blocks beta 1 and beta 2 receptors in the hearts in the heart lungs and systemically okay okay so because it's non-selective and it's going to affect beta 1 and beta 2 receptors which we know beta 2 consists of the lungs and systemically right beta 1 is heart we have to be really careful and cautious about using this in patients that have any type of known pulmonary diseases or illness okay what happens is these particular drug or this particular drug class can cause vasodilation right which can be great right because it's going to help lower blood pressure but it also will cause bronchial constriction so think if we're blocking beta 2 receptors what if the patient is on medication that is specifically for a pulmonary disease right to help with their lungs but if we're giving them something that is non-selective and affects those beta2 receptors that medication might not work effectively and we could cause bronchial constriction right we need our bronchioles nice and open so we have a nice patent airway okay um and then also it will decrease run in secretion and so remember where does running come from running comes from the kidneys and it stimulates um it stimulates basically that raw system where we actually have um the conversion of an angiotensinogen that converts to ace one to h2 and then so on and so far throughout the ross process therapeutic effects so therapeutically you really want to remember what's happening here with this particular class of drug okay we are decreasing blood pressure that's ultimately we want to achieve right so if we d we decrease blood pressure we're decreasing constriction we're decreasing resistance we're decreasing after load you've seen all that already okay what's different is that this particular drug works on the heart's electrical conduction system right so if it's working on that conduction system it's this particular class is going to decrease the heart rate so what happens is we have a decrease of that sinoatrial node firing remember that's our sa node our pacemaker of the heart okay so we call this as a negative chronotrope anything that's going to decrease the heart rate and works on that sa node is called a negative chronotrope so how i try to remember this is chronotrope starts with the word letter c right prone negative chronotrope okay carnotrop c conduction system also starts with feed so i know that anything that is a chronotrope works on the conduction system of the heart the electrical conduction system it's going to affect the heart rate so it could be a positive chronotrope or a negative chronotroph so if it was positive it's going to speed up the heart rate if it's negative it's going to slow the heart rate down so this is a negative chronotrope so beta blockers are going to decrease the blood pressure but also decrease the heart rate that's different than any of the classes that we've talked about so far so when we're going through these medications you're going to see a lot of things that are very similar or the same right and you're like oh my gosh you're so much how do i differentiate really the biggest thing to remember i feel that's easiest and a shorter list to try and memorize are those things that make the medications different not the same what makes them different so so far what makes them different is how this particular class works on the electrical conduction system of the heart okay this drug also decreases myocardial contractility so if we have decreased myocardial contractility right so that's the force of contraction of the heart that's what we're talking about when i say that we're going to decrease the oxygen requirements of those myocardial cells important to remember for this decreases myocardial contractility decreases o2 requirements of the myocardial cells so we call this a negative ionotrope okay so chronotrope we're referring to the electrical conduction system right whether it's negative or positive so the heart rate is either faster or slower when we're talking about an ionotrope we're talking about the force of contractility okay so if we decrease the force of contractility the heart doesn't need as much oxygen right we decrease the o2 requirements of those cells so this is a negative ionotrope okay so chronotrope electrical conduction affects sa no firing ionotrope is the force of contractility either positive or negative okay so you need to remember the differences between those and these therapeutic effects that i'm talking about indications well we would give it for someone for high blood pressure right hypertension we could also give it for someone who to someone who has angina or chest pain because why it helps to decrease that o2 demand of the myocardium so those heart cells don't need as much oxygen or don't have as much oxygen demand and it helps alleviate the pain dysrhythmia so if a patient had a particular type of cardiac rhythm disturbance we can use it for that as well and then also left ventricular systolic function okay precautions so for precautions we have concurrent use of multiple drugs affecting the blood pressure again because we're going to increase those hypotensive effects and then pulmonary disease or illness so this would be for remember non-selective right so non-selective um beta adrenergic blockers are going to have this particular effect why because it works on the beta 1 and beta 2 receptors beta 1 heart beta 2 lungs okay important to remember that uh we could give it or sorry precautions would also be heart failure so again if there's some type of some cardiac dysrhythmias we want to be really careful about that because if it's a dysrhythmia that has a slow dysrhythmia so like bradycardia right bradycardia is a slow heart rate less than 60. so if that heart rate is slow we know the side effect of this particular drug is going to slow the heart rate and lower the blood pressure though that's a problem right so that's a nursing judgment call if we go assess it because you want to take a blood pressure heart rate before you give any type of um cardiac medication right so if we go assess the blood pressure and heart rate and we see that the heart rate is low and or the blood pressure is low and we know on our heads this drug is going to lower the heart rate and lower the blood pressure nursing judgment call am i going to hold it i think i am and i'm going to call the provider and let them know what's going on and why i decided to hold it and see if they want to change it to something else that also can mask the um evidence of hypoglycemia so this would be someone with low blood sugar so how it does this is it basically just blunts the beta effects that we have of adrenaline and other related substances so if a patient were to have hypoglycemia they might not experience the typical adrenergic warning symptoms such as tremors and palpitations because this particular drug class blocks that so that's just a fun tidbit to know nothing you would need to know that for testing purposes but it's something to keep in mind when you're medicating patients with these types of medications contraindications um so some pulmonary diseases and some cardiac dysrhythmias which we pretty much already talked about side effects congestive heart failure um and some cardiac rhythm is again um the bradycardia is the biggest one that you really want to watch for because that's a slower heart rate and the drug is going to slow the heart rate down so that would be bad and then bronchos spasms or bronchos so this would be for your non-selective beta-adrenergic blockers right because they actually affect the beta-2 receptors so the patient could have dyspnea meaning difficulty breathing or wheezing and then just also another factor is the fatigue a patient could have depression and impotence is a big one with some of these medications for men so for nursing actions we have assessment um what are we going to assess we're going to make sure that we're assessing the blood pressure the patient's heart rate right those are all very important so we want to make sure we're checking their pulmonary status so we're putting our stethoscope on their chest and listening to their breast sounds and again assessing that blood pressure heart rate and then we're also looking at eyes and o's right and taking output daily weights side effects these are things that we always need to keep in mind with medications when we administer them physical assessment cardiac pulmonary there it is again and then patient education is the same okay talking about the side effects of the drugs they need to know in particular what's different about this is if you saw on the other classes that we talked about thus far they need to know how to monitor their own blood pressure that is the same for this particular class but what also is important because we know it lowers the heart rate is a patient needs to know how to check their heart rate right so they need to have what's a normal heart rate and how do i feel for a pulse and check it okay those are educational points that you want to remember for this particular class other drugs which may interact possibly again hypotensive or even hypertensive symptoms if the medication's not working uh renal function in terms of education it's just the provider might happen to order you know check their renal function function every so often it's not like they need to know what our normal renal function values and then symptoms related to serum blood uh blood glucose so remember it might blunt the effects of if they were to be hypoglycemic they might not they might not know it or have the same symptoms because that effect is actually blunted so for examples of drugs in class you're only going to be again it's this the three medications that are starred here our asterisks are our prototypes you have propanol metropole and a tennolo so you see olal is our suffix um that will tell you that this is a beta adrenergic blocker so to differentiate them propanolol is a non-selective beta anti-nurture blocker and then both metropole and atenolol are your selective beta adrenergic blockers so you know the difference between the 3d okay so